Key takeaways
- Botox can interact with certain antibiotics, including tobramycin (Bethkis, Tobi, others), amikacin, gentamicin, colistimethate, and streptomycin. Taking these medications together can lead to a loss of muscle function and problems with movement.
- Taking a muscle relaxer with Botox can increase the risk of excessive muscle weakness, as both drugs can cause muscle weakness when used individually.
- Botox and anticholinergics can both cause certain side effects, including constipation and dry mouth, so taking these drugs together can raise your risk of these side effects.
Botox is used to treat:
- urinary incontinence related to a problem with the nervous system in adults
- overactive bladder in adults and children
- cervical dystonia in adults
- excessive sweating in the armpits in adults
- spasticity in the arms or legs in adults and children
- uncontrollable eyelid twitching in adults and children
- crossed eyes in adults and children
It is also used to help prevent headaches related to chronic migraine in adults.
An interaction can occur because one substance causes another substance to have a different effect than expected. Interactions can also occur if you have certain health conditions.
Keep reading to learn about Botox’s possible interactions.
Note: In this article, we describe interactions of Botox that is used for medical purposes. You can talk with your doctor to learn more about the interactions of Botox that is used for cosmetic reasons.
Before you start receiving Botox injections, tell your doctor and pharmacist about any prescription, over-the-counter, or other drugs you take. Sharing this information with them may help prevent possible interactions.
If you have questions about drug interactions that may affect you, talk with your doctor or pharmacist.
The following table lists drugs that may interact with Botox. Keep in mind that this table does not include all drugs that may interact with Botox. For more information about some of these interactions, see the “Drug interactions explained” section.
| Drug group or drug name | Drug examples | What can happen |
|---|---|---|
| certain antibiotics | • amikacin (Arikayce) • gentamicin • colistimethate (Coly-Mycin M) • tobramycin (Bethkis, Tobi, others) • streptomycin | can increase the risk of muscle-related side effects from Botox |
| muscle relaxers | • baclofen (Lyvispah, Ozobax DS, others) • carisoprodol (Soma) • cyclobenzaprine (Amrix) • metaxalone • methocarbamol (Robaxin) | can increase the risk of excessive muscle weakness |
| anticholinergics | • benztropine • hyoscyamine (Hyosyne, Levsin, others) • oxybutynin (Oxytrol) • scopolamine (Transderm Scop) • tolterodine (Detrol, Detrol LA) | can increase the risk of side effects from Botox and the anticholinergic |
| other products that contain botulinum toxin | • Botox Cosmetic (onabotulinumtoxinA) • Daxxify (daxibotulinumtoxinA-lanm) • Dysport (abobotulinumtoxinA) • Jeuveau (prabotulinumtoxinA-xvfs) • Xeomin (incobotulinumtoxinA) | can increase the risk of excessive muscle weakness |
Certain health conditions or other factors could raise your risk of harm if you take Botox. In such cases, your doctor may not prescribe Botox for you. These are known as contraindications. The list below includes contraindications of Botox.
If you have an infection at the injection site: If you have an infection in the area where Botox will be injected, your doctor likely will not prescribe Botox for you. They may treat the infection before you receive Botox or recommend other treatments instead.
If you have certain urinary problems: If you have certain urinary problems, your doctor likely will not prescribe Botox for treating urinary incontinence or overactive bladder. These problems include:
- urinary tract infection (UTI)
- urinary retention without the use of a catheter to empty your bladder
This is because receiving Botox could worsen UTI or urinary retention. You can ask your doctor about other treatments that may be better options for you.
If you’ve had an allergic reaction: If you’ve had an allergic reaction to Botox or any of its ingredients, your doctor likely will not prescribe Botox for you. This is because receiving the injection could cause another allergic reaction. You can ask your doctor about other treatments that may be better options for you.
Before you start receiving Botox injections, talk with your doctor if any of the factors above apply to you. Your doctor can determine whether Botox treatment is safe for you.
Botox is not known to interact with alcohol.
But Botox and alcohol can cause some similar side effects. Examples include headache, dizziness, and fatigue. So you may be more likely to experience these side effects if you drink alcohol during your Botox treatment.
If you have questions about consuming alcohol during Botox treatment, talk with your doctor or pharmacist.
Learn more about certain drug interactions that can occur with Botox.
Interaction with certain antibiotics
Botox can interact with certain antibiotics, which are used to treat bacterial infections.
Examples of antibiotics that may interact with Botox include:
- amikacin (Arikayce)
- gentamicin
- colistimethate (Coly-Mycin M)
- tobramycin (Bethkis, Tobi, others)
- streptomycin
What could happen
Taking certain antibiotics during Botox treatment may enhance the effect of Botox. This is because Botox works by blocking nerve signals to your muscles. Certain antibiotics can also affect your muscle strength.
So, taking these drugs together could further increase the effect of Botox.
What you can do
Your doctor can recommend whether it’s safe to take certain antibiotics with Botox. If they prescribe these drugs together, your doctor may have you watch closely for side effects of Botox or the antibiotic. They’ll tell you how to manage these side effects and whether it’s safe to continue treatment with either drug.
If you have questions about taking certain antibiotics during Botox treatment, talk with your doctor or pharmacist.
Interaction with muscle relaxers
Botox can interact with muscle relaxers. These drugs are used to treat some of the same conditions as Botox, including spasticity and cervical dystonia.
Examples of muscle relaxers include:
- baclofen (Lyvispah, Ozobax DS, others)
- carisoprodol (Soma)
- cyclobenzaprine (Amrix)
- metaxalone
- methocarbamol (Robaxin)
What could happen
Taking a muscle relaxer with Botox can increase the risk of excessive muscle weakness. Both drugs can cause muscle weakness when used individually. Taking them together can raise the risk of this effect.
What you can do
If you take a muscle relaxer with Botox, tell your doctor right away if you have symptoms of excessive muscle weakness. These may include difficulty swallowing, breathing, speaking, or walking. If your symptoms seem severe or life threatening, call 911 or your local emergency number.
If you have questions about taking a muscle relaxer during Botox treatment, talk with your doctor or pharmacist.
Interaction with anticholinergics
Botox can interact with anticholinergics. These drugs are used to treat some of the same conditions as Botox, including overactive bladder.
Examples of anticholinergic medications include:
- benztropine
- hyoscyamine (Hyosyne, Levsin, others)
- oxybutynin (Oxytrol)
- scopolamine (Transderm Scop)
- tolterodine (Detrol, Detrol LA)
What could happen
Botox and anticholinergics can both cause certain side effects, including constipation and dry mouth. So taking these drugs together can raise your risk of these side effects.
What you can do
If you take an anticholinergic with Botox, tell your doctor right away if you have worsened side effects from either drug. They’ll tell you how to manage these side effects and whether it’s safe to continue treatment with either drug.
If you have questions about taking an anticholinergic during Botox treatment, talk with your doctor or pharmacist.
Not reported to interact with Botox
- vitamins, herbs, or supplements
- specific foods
- vaccines
- lab tests
- cannabis (commonly called marijuana) or cannabidiol (CBD)
Certain medical conditions or other health factors may raise the risk of interactions with Botox. Before using Botox, talk with your doctor about your health history. They’ll determine whether Botox is right for you.
Health conditions or other factors that might interact with Botox include:
- preexisting infection at the injection site
- urinary tract infection or urinary retention
- a nervous system condition, such as myasthenia gravis or amyotrophic lateral sclerosis (ALS)
- upcoming surgeries or major medical procedures
- previous surgery on your face
- weak forehead muscles, such as difficulty raising your eyebrows
- drooping eyelids
- difficulty swallowing or breathing
- pregnancy or breastfeeding
- previous allergic reaction or side effects from any form of Botox
Quick tip: It may be helpful to revisit this information if your routine changes.
Taking certain steps can help you avoid interactions with Botox. Before starting treatment, talk with your doctor and pharmacist. Things to discuss with them include:
- whether you drink alcohol or use cannabis
- other medications you take, as well as any vitamins, supplements, and herbs (they can also help you fill out a
medication list ) - what to do if you start taking a new drug during your Botox treatment
It’s also important to understand Botox’s
If you did not get paperwork with Botox, ask your pharmacist to print a copy for you. If you have trouble reading or understanding this information, your doctor or pharmacist can help.
Using Botox exactly as prescribed can also help prevent interactions.